Quantum Work Statistics at Strong Reservoir Coupling.

Determining the statistics of work done on a quantum system while strongly coupled to a reservoir is a formidable task, requiring the calculation of the full eigenspectrum of the combined system and reservoir. Here, we show that this issue can be circumvented by using a polaron transformation that maps the system into a new frame where weak-coupling theory can be applied. Crucially, this polaron approach reproduces the Jarzynski fluctuation theorem, thus ensuring consistency with the laws of stochastic thermodynamics. We apply our formalism to a system driven across the Landau-Zener transition, where we identify clear signatures in the work distribution arising from a non-negligible coupling to the environment. Our results provide a new method for studying the stochastic thermodynamics of driven quantum systems beyond Markovian, weak-coupling regimes.

Examining the validity of eye tracking during the computerized Wisconsin card sorting test in a sample of stroke patients and healthy controls.

INTRODUCTION: Each year, approximately 50,000 Canadians, one million Americans, and millions of people worldwide are hospitalized for stroke. Cognitive impairment is common after experiencing a stroke and is known to affect functioning on daily tasks. While neuropsychological assessments are often employed to assess cognitive abilities and make inferences about functional capabilities, there is growing interest in integrating contemporary technologies to augment assessment. Eye tracking allows previously overlooked information, such as overt visual attention based on fixations and saccades, to be quantified to help elucidate how responses are made during testing. METHOD: The current study investigated the validity of eye tracking during completion of the computerized Wisconsin Card Sorting Test (cWCST), a common test of higher level cognition, in a sample of inpatients recovering from stroke (n= 41) and a control group of healthy individuals (n = 46). RESULTS: Results provided supporting evidence for the construction, criterion, and ecological validity of eye tracking on the cWCST with inpatients recovering from a stroke. Specifically, eye tracking metrics differentiated between inpatients and controls; fixations on cWCST areas of interest differed between type of response (conceptual versus non-conceptual); and average time per fixation predicted functional status early after a stroke as well as recovery during inpatient rehabilitation, above-and-beyond cWCST scores. Time spent on testing negated the effects of fixation and saccade counts for predicting cWCST performance, due to the substantial overlap in variance. CONCLUSION: Current findings of this preliminary study provided support for the validity of eye tracking, integrated with the cWCST, for inpatients recovering from a stroke. Implications and areas for future research are discussed.

A psychometric examination of the PAI-SF in persons with recent stroke.

Objective: The present study evaluated the psychometric properties of the Personality Assessment Inventory-Short Form (PAI-SF) for use with patients with recent stroke. Method: Study participants (N = 170) were inpatients in a tertiary hospital in Western Canada admitted to a rehabilitation department who completed a neuropsychological evaluation as part of their care. All participants completed the full-form of the PAI (344 items) and both full- and short-form (160 items) versions were scored from the same protocol. Results: Internal consistency for the PAI-SF scales was assessed by Cronbach's coefficient alpha. Alpha coefficients for clinical scales fell between the range of 0.53 (ANT) to 0.88 (ANX), with three scales (ANT, ALC, and DRG) falling below satisfactory (<0.70). Alpha coefficients were unsatisfactory for validity, treatment, and interpersonal scales. Absolute differences between mean clinical scale t scores between the full and short-form PAI clinical scales ranged from 0.04 (DEP) to 1.18 (MAN). For an individual, absolute differences in scale t scores between the full- and short-forms ranged from 0 to 30 t scores. On average, an individual varied 3.75 t scores between the PAI full- and short-form across all validity, clinical, interpersonal, and treatment scales. Component structure was similar across the full- and short-forms. Conclusions: Findings are somewhat consistent with previous literature on the PAI-SF as the full- and short-forms had minimal differences and similar psychometric properties. However, caution is warranted for the clinical utility for both forms given the lower alpha coefficients and different structure. Only certain clinical scales appear to have strong psychometric properties.

Joint statistics of work and entropy production along quantum trajectories.

In thermodynamics, entropy production and work quantify irreversibility and the consumption of useful energy, respectively, when a system is driven out of equilibrium. For quantum systems, these quantities can be identified at the stochastic level by unravelling the system's evolution in terms of quantum jump trajectories. We here derive a general formula for computing the joint statistics of work and entropy production in Markovian driven quantum systems, whose instantaneous steady states are of Gibbs form. If the driven system remains close to the instantaneous Gibbs state at all times, then we show that the corresponding two-variable cumulant generating function implies a joint detailed fluctuation theorem so long as detailed balance is satisfied. As a corollary, we derive a modified fluctuation-dissipation relation (FDR) for the entropy production alone, applicable to transitions between arbitrary steady states, and for systems that violate detailed balance. This FDR contains a term arising from genuinely quantum fluctuations, and extends an analogous relation from classical thermodynamics to the quantum regime.

Thermodynamic Uncertainty Relation in Slowly Driven Quantum Heat Engines.

Thermodynamic uncertainty relations express a trade-off between precision, defined as the noise-to-signal ratio of a generic current, and the amount of associated entropy production. These results have deep consequences for autonomous heat engines operating at steady state, imposing an upper bound for their efficiency in terms of the power yield and its fluctuations. In the present Letter we analyze a different class of heat engines, namely, those which are operating in the periodic slow-driving regime. We show that an alternative TUR is satisfied, which is less restrictive than that of steady-state engines: it allows for engines that produce finite power, with small power fluctuations, to operate close to reversibility. The bound further incorporates the effect of quantum fluctuations, which reduces engine efficiency relative to the average power and reliability. We finally illustrate our findings in the experimentally relevant model of a single-ion heat engine.

Geometric Optimisation of Quantum Thermodynamic Processes.

Differential geometry offers a powerful framework for optimising and characterising finite-time thermodynamic processes, both classical and quantum. Here, we start by a pedagogical introduction to the notion of thermodynamic length. We review and connect different frameworks where it emerges in the quantum regime: adiabatically driven closed systems, time-dependent Lindblad master equations, and discrete processes. A geometric lower bound on entropy production in finite-time is then presented, which represents a quantum generalisation of the original classical bound. Following this, we review and develop some general principles for the optimisation of thermodynamic processes in the linear-response regime. These include constant speed of control variation according to the thermodynamic metric, absence of quantum coherence, and optimality of small cycles around the point of maximal ratio between heat capacity and relaxation time for Carnot engines.

Quantum Fluctuations Hinder Finite-Time Information Erasure near the Landauer Limit.

Information is physical but information is also processed in finite time. Where computing protocols are concerned, finite-time processing in the quantum regime can dynamically generate coherence. Here we show that this can have significant thermodynamic implications. We demonstrate that quantum coherence generated in the energy eigenbasis of a system undergoing a finite-time information erasure protocol yields rare events with extreme dissipation. These fluctuations are of purely quantum origin. By studying the full statistics of the dissipated heat in the slow-driving limit, we prove that coherence provides a non-negative contribution to all statistical cumulants. Using the simple and paradigmatic example of single bit erasure, we show that these extreme dissipation events yield distinct, experimentally distinguishable signatures.

Geometry of Work Fluctuations versus Efficiency in Microscopic Thermal Machines.

When engineering microscopic machines, increasing efficiency can often come at a price of reduced reliability due to the impact of stochastic fluctuations. Here we develop a general method for performing multiobjective optimization of efficiency and work fluctuations in thermal machines operating close to equilibrium in either the classical or quantum regime. Our method utilizes techniques from thermodynamic geometry, whereby we match optimal solutions to protocols parametrized by their thermodynamic length. We characterize the optimal protocols for continuous-variable Gaussian machines, which form a crucial class in the study of thermodynamics for microscopic systems.

Work Fluctuations in Slow Processes: Quantum Signatures and Optimal Control.

An important result in classical stochastic thermodynamics is the work fluctuation-dissipation relation (FDR), which states that the dissipated work done along a slow process is proportional to the resulting work fluctuations. We show that slowly driven quantum systems violate this FDR whenever quantum coherence is generated along the protocol, and we derive a quantum generalization of the work FDR. The additional quantum terms in the FDR are found to lead to a non-Gaussian work distribution. Fundamentally, our result shows that quantum fluctuations prohibit finding slow protocols that minimize both dissipation and fluctuations simultaneously, in contrast to classical slow processes. Instead, we develop a quantum geometric framework to find processes with an optimal trade-off between the two quantities.

Walk, Talk and Listen: a pilot randomised controlled trial targeting functional fitness and loneliness in older adults with hearing loss.

BACKGROUND: Age-related hearing loss (HL) is a prevalent disability associated with loneliness, isolation, declines in cognitive and physical function and premature mortality. Group audiological rehabilitation (GAR) and hearing technologies address communication and cognitive decline. However, the relationship between loneliness, physical function and GAR among older adults with HL has not been studied. OBJECTIVES: Explore the impact of a group exercise and socialisation/health education intervention and GAR on physical function and loneliness among older adults with HL. TRIAL DESIGN: A Young Men's Christian Association (YMCA)-based, 10-week, single-blind, pilot randomised controlled trial (RCT). PARTICIPANTS: Ambulatory adults aged 65 years or older with self-reported HL. INTERVENTIONS: Seventy-one participants were screened. Thirty-five were randomised to intervention (strength and resistance exercise, socialisation/health education) and GAR (hearing education, communication strategies, psychosocial support) or control (n=31): GAR only. OUTCOMES: Ninety-five per cent of eligible participants were randomised. GAR and exercise adherence rates were 80% and 85%, respectively. 88% of participants completed the study. Intervention group functional fitness improved significantly (gait speed: effect size: 0.57, 30 s Sit to Stand Test: effect size: 0.53). Significant improvements in emotional and social loneliness (effect size: 1.16) and hearing-related quality of life (effect size: 0.76) were related to GAR attendance and poorer baseline hearing-related quality of life. Forty-two per cent of participants increased social contacts outside the study. DISCUSSION: Walk, Talk and Listen was feasible and acceptable. Exercise and socialisation/health education improved loneliness and key fitness measures but provided no additional benefit to GAR only for loneliness. This is the first preliminary evidence about the benefits of exercise on fitness and GAR on loneliness among older adults with HL. IMPLICATIONS: This pilot trial provides key information on the sample size required for a larger, longer term RCT to determine the enduring effects of this holistic intervention addressing the negative psychosocial and musculoskeletal downstream effects of HL among older adults.

Allocentric Versus Egocentric Neglect in Stroke Patients: A Pilot Study Investigating the Assessment of Neglect Subtypes and Their Impacts on Functional Outcome Using Eye Tracking.

OBJECTIVE: Few studies have investigated the assessment and functional impact of egocentric and allocentric neglect among stroke patients. This pilot study aimed to determine (1) whether allocentric and egocentric neglect could be dissociated among a sample of stroke patients using eye tracking; (2) the specific patterns of attention associated with each subtype; and (3) the nature of the relationship between neglect subtype and functional outcome. METHOD: Twenty acute stroke patients were administered neuropsychological assessment batteries, a pencil-and-paper Apples Test to measure neglect subtype, and an adaptation of the Apples Test with an eye tracking measure. To test clinical discriminability, twenty age- and education-matched control participants were administered the eye tracking measure of neglect. RESULTS: The eye tracking measure identified a greater number of individuals as having egocentric and/or allocentric neglect than the pencil-and-paper Apples Test. Classification of neglect subtype based on eye tracking performance was a significant predictor of functional outcome beyond that accounted for by the neuropsychological test performance and Apples Test neglect classification. Preliminary evidence suggests that patients with no neglect symptoms had superior functional outcomes compared with patients with neglect. Patients with combined egocentric and allocentric neglect had poorer functional outcomes than those with either subtype. Functional outcomes of patients with either allocentric or egocentric neglect did not differ significantly. The applications of our findings, to improve neglect detection, are discussed. CONCLUSION: Results highlight the potential clinical utility of eye tracking for the assessment and identification of neglect subtype among stroke patients to predict functional outcomes. (JINS, 2019, 25, 479-489).

Comparison of the Buschke Selective Reminding Test and the California Verbal Learning Test - Second Edition in a heterogeneous sample of people with traumatic brain injury.

This study examined score and classification differences between the Buschke Selective Reminding Test (SRT) and the California Verbal Learning Test - Second Edition (CVLT-II) in a TBI sample. Seventy-nine participants with traumatic brain injury (TBI) were included and were comprised of 49 mild TBI, 11 moderate TBI, and 14 severe TBI. The majority of participants with mild TBI were involved in litigation. Scores were compared between the CVLT-II and SRT on the total sample and after segregating TBI severity. Correlations between the SRT and CVLT-II were variable (r = .23 to .72). Total List score was lower on the SRT across all levels of TBI severity (p < .006). Learning score was lower on the SRT in mild and severe TBI groups (p < .006). Long delay free recall score was lower on the SRT in mild TBI group only (p < .006). Across TBI severity, lower scores were found on the CVLT-II between severe and mild TBI (p = .04). Scores on the SRT did not differ between TBI severities. The two tests appear to provide different clinical interpretations in a TBI sample. Results may be due to features of the normative data, test procedures, and/or word lists. Clinical implications and limitations are discussed.

Assessing the predictive value of a neuropsychological model on concurrent function in acute stroke recovery and rehabilitation.

Objective: Few studies have examined the relationship between cognition and function for acute stroke inpatients utilizing comprehensive methods. This study aimed to assess the relationship of a neuropsychological model, above and beyond a baseline model, with concurrent functional status across multiple domains in the early weeks of stroke recovery and rehabilitation. Method: Seventy-four acute stroke patients were administered a comprehensive neuropsychological assessment. Functional domains of ability, adjustment, and participation were assessed using the Mayo-Portland Adaptability Inventory - 4 (MPAI-4). Hierarchical linear regression was used to assess a neuropsychological model comprised of cognitive tests scores on domains of executive function, memory, and visuospatial-constructional skills (VSC), after accounting for a baseline model comprised of common demographic and stroke variants used to predict outcome. Results: The neuropsychological model was significantly associated, above and beyond the baseline model, with MPAI-4 Ability, Participation, and Total scores (all p-values < .05). The strength of association varied across functional domains. Analyzing tests of executive function, the Color Trails Test-Part 2 predicted MPAI-4 Participation (ß = -.46, p = .001), and Total score (ß = -.32, p = .02). Conclusion: Neuropsychological assessment contributes independently to the determination of multiple domains of functional function, above and beyond common medical variants of stroke, in the early weeks of recovery and rehabilitation. Multiple tests of executive function are recommended to develop a greater appreciation of a patient's concurrent functional abilities.

Psychological disturbance and cognitive functioning in TBI patients.

The current study examined psychopathology and neuropsychological test performance in a traumatic brain injury (TBI) patient sample. Previous research has found that the Minnesota Multiphasic Personality Inventory - Second Edition (MMPI-2) indices of psychological disturbance were related to specific neuropsychological tests of attention and memory. Furthermore, higher scores on clinical scale 2 (Depression) and higher scores on the content scales of Fears and Bizarre Mentation of the MMPI-2 were related to poorer performance in, most notably, Attention and List Learning factors. The present study sought to extend the research by adding a neuropsychological measure of conceptual reasoning. A sample of 116 TBI patients referred for evaluation at a private practice clinic were administered a battery of neuropsychological measures of list learning, working memory, verbal memory, visuographic memory, and conceptual reasoning, as well as the MMPI-2 to assess emotional functioning. Regression analysis indicated that an overall model of MMPI-2 indices significantly predicted poorer performance on List Learning. More specifically, higher scores on the content scales of Obsessions and Fears were most robustly associated with poorer neuropsychological test performance for List Learning and Working Memory respectively. Findings suggest psychopathology is correlated with performance on neuropsychological measures for TBI patients.

Reflecting on what? The difficulty of noticing formative experiences in the moment.

INTRODUCTION: In the spirit of enacting an educational model of guided, collective reflection to support positive professional identity construction in healthcare learners, we implemented a reflection-based course for medical students transitioning to clerkship with three goals: to sensitize learners to the hidden curriculum; to provide a safe and confidential forum to discuss their experiences; and to co-construct strategies to deal with the pressures in the clinical environment METHODS: We used a design-based research protocol. Twelve students participated in ten sessions starting during their transition to clerkship. Faculty debriefed after each session, adjusting the format of the subsequent sessions. Data included student logs, transcripts of the course sessions, faculty debriefings, and the course evaluation. Data were analyzed via an iterative process of independent coding and discussion. RESULTS: The main adjustments to the course were to eliminate didactic content in favour of using prompts prior to course sessions and de-emphasizing written reflection. Participants felt the course achieved its three goals and students reported enhanced resiliency during transition to clerkship, although, despite prompting, students offered no examples of their joining in with the negative behaviours around them. CONCLUSIONS: The course was successful in its key objectives. However, a key aspect of reflection, students noticing their own behaviour in the moment as something that needs to be reflected on, was challenging. Future research exploring the value of reflection as an intervention to redress the unwanted aspects of the hidden curriculum might focus on efforts to move the students to explicitly explore the enculturation process in themselves.

Targeting the psychosocial and functional fitness challenges of older adults with hearing loss: a participatory approach to adaptation of the walk and talk for your life program.

OBJECTIVE: Explore the acceptability of a socialisation, health education and falls prevention programme (Walk and Talk for Your Life: WTL) as an adjunct to group auditory rehabilitation (GAR) and how it might be adapted for older adults with hearing loss (HL). DESIGN: Content theme analysis (CTA) of guided interviews explored the experience of HL, the acceptability of a WTL programme and suggestions on how to adapt the WTL programme to better suit the needs of older adults with HL. STUDY SAMPLE: Twenty-eight (20 women, 8 men) adults (>55 years of age) with HL were interviewed. Seventeen had participated in past WTL programmes and eleven were sampled from the community. RESULTS: Interviewees reported difficulty socialising and a tendency to withdraw from social interactions. Addition of GAR to a WTL programme was found to be highly acceptable. Interviewees suggested that to best suit their needs, sessions should take place in a location with optimal acoustics; include small groups integrating hearing-impaired and hearing-intact participants; include appropriate speaking ground rules; and include an option for partner involvement. CONCLUSIONS: The adapted WTL programme provides a holistic and unique approach to the treatment of HL that has the potential to positively impact the hearing-impaired elderly.

Leggett-Garg Inequalities for Quantum Fluctuating Work.

The Leggett-Garg inequalities serve to test whether or not quantum correlations in time can be explained within a classical macrorealistic framework. We apply this test to thermodynamics and derive a set of Leggett-Garg inequalities for the statistics of fluctuating work done on a quantum system unitarily driven in time. It is shown that these inequalities can be violated in a driven two-level system, thereby demonstrating that there exists no general macrorealistic description of quantum work. These violations are shown to emerge within the standard Two-Projective-Measurement scheme as well as for alternative definitions of fluctuating work that are based on weak measurement. Our results elucidate the influences of temporal correlations on work extraction in the quantum regime and highlight a key difference between quantum and classical thermodynamics.

Comparison of the Buschke Selective Reminding Test and the California Verbal Learning Test-Second Edition in a stroke population.

There are many tests of learning and memory; however, not all yield analogous results and thus are not interchangeable. This study examined the relationship between the California Verbal Learning Test-Second Edition (CVLT-II) and the Buschke Selective Reminding Test (SRT) in a stroke population. Data from stroke inpatients (N = 102) referred for rehabilitation were collected from medical records. Both tests were administered, as part of a larger neuropsychological assessment. Analyses were conducted on Z-scores from the List Total, Learning, and Long Delay Free Recall (LDFR) subscales of the two tests. SRT and CVLT-II scores were significantly correlated (r = .34 to .52, all p values <.001). However, scores were significantly worse on the SRT compared to the CVLT-II (d = -.90 to - 1.46, all p values <.001). Left hemisphere strokes performed worse than right hemisphere strokes on both tests; however, this trend was not significant. The SRT appeared to be more sensitive to impairment than the CVLT-II; thus, the two tests may not be interchangeable in a stroke population.

(Almost) forgetting to care: an unanticipated source of empathy loss in clerkship.

CONTEXT: The erosion of empathy in medical students is well documented. Both the hidden curriculum associated with poor role modelling and a sense of burnout have been proposed as key factors, but the precise mechanisms by which this loss of empathy occurs have not been elaborated. OBJECTIVES: In the context of a course designed to help students manage the hidden curriculum, we collected data that raised questions about current conceptualisations of the aspects of medical training that lead to loss of empathy. METHODS: We held nine sessions in the first year of clinical clerkship, in which we asked students to bring to the group their experiences of the hidden curriculum for reflection. Course sessions were recorded, transcribed and qualitatively analysed, and themes were generated for further exploration. RESULTS: We identified an identity developmental trajectory in early clerkship in which students started with feelings of excitement, transitioned quickly to 'shock and awe', progressed into 'survival mode' and then passed into a stage of 'recovery'. Interestingly, in the early stages, students' sense of empathic virtuosity was reinforced. It was not until later, when students were more comfortable in their clinical role, that they reported their tendency to connect with the patient only as an afterthought to the encounter, or not at all, and needed to remind themselves to care. CONCLUSIONS: We offer new data for consideration with regard to medical students' loss of empathy during early clinical training that suggest it is the process of making patient care routine that shifts the patient from the status of an individual with suffering to the object of the work of being a physician.